Jonathan P Ludlow, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV0061121 Issued in NY

Practice address

10730A Enduring Freedom Dr Ste a
Fort Drum, NY 13602-5405

Phone

(315) 405-8671

Fax

(315) 773-1820

NPI assigned

Nov 15, 2005

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Watertown Medical Optical PLLC

  • Eyewear Supplier
  • Gouverneur, NY
  • NPI 1407319155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1417939604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730A ENDURING FREEDOM DR",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025405",
            "telephone_number": "315-405-8671",
            "fax_number": "315-971-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730A ENDURING FREEDOM DR STE A",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025405",
            "telephone_number": "315-405-8671",
            "fax_number": "315-773-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUDLOW",
        "first_name": "JONATHAN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV0061121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BNY",
            "identifier": "G0185822450",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE",
            "identifier": "TUV006112",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02008780",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "410043899",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "52833A",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nycole Lively-Pagliuca, LCSW, CADC
• Gregory Laurence Livingston, O.D.
• Mario Lopez, DENTAL ASSISTANT X2
• Mildred Rodriguez Lopez, BSN, RN, IBCLC
• Ronald Lovich, D.O.
• Michelle Luken, BS/MS, OTR/L
• Quan M Luong, D.O.
• Michelle Luther
• Vania Ma, MD
• Wael K Mabrouk, DMD

• Optometrist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.